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Provider Information Data Specialist

Company: Fallon Community Health Plan
Location: Worcester
Posted on: January 15, 2022

Job Description:

Provider Information Data SpecialistUS-MA-WorcesterJob ID: 6676Type: Full Time# of Openings: 1Category: Provider RelationsFallon Health - Corp HQOverviewFallon Health Vaccination Requirements:To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as "Remote" require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment. The Provider Information Data Specialist position is Hybrid working 3 days/week in Worcester, Ma office + 2 day/week working at home. About Fallon HealthFounded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation's top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.Brief summary of purpose:The Provider Information Data Specialist respond to physician, hospital, ancillary provider inquiries and requests for services associated with the resolution of provider complaints relating to operational concerns, policy and procedures for Fallon Health products and subsidiaries. Understand Fallon Health policies and facilitate and the research required to resolve provider issues. Work collaboratively with internal departments to resolve provider items and look for process improvements. Validate and Update provider demographic and practice changes applicable to the assigned provider territory. Update provider demographic and non contractual changes in QNXT/eVips accurately and timely.ResponsibilitiesThe Provider Information Data Specialist responsibilities include:Receive daily correspondence from assigned physicians, hospitals, and ancillary providers requesting information and services. Act as primary point of contact with assigned providers by promoting a one-stop customer service for escalated provider service issues. Escalations come from internal departments and external provider contacts.Utilize appropriate internal resources in order to analyze and resolve issues.Monitor status of QNXT cases thru to resolution status. Maintain detailed documentation within QNXT cases. Conduct proactive follow-up activities with provider and/or Fallon Health staff.Validate data received by providers and update demographic and practice changes at the request of the assigned provider. Adhere to departmental, corporate standards and policy and procedure (i.e. Fallon Health Service Level agreements) issue resolution timeframes, PUNKS, QNXT case inventory/assignments, etc.)QualificationsEducation:Bachelor's degree or equivalent combination of training and experience Experience2 years' experience in a customer service role for a healthcare services organizationProficiency with desktop computer applications, Microsoft Office package, mainframe knowledge (QNXT/eVips)Knowledge of medical terminology/claims payment, ICD and CPT coding familiarityExemplary customer relations expertiseClear concise written and verbal communication skillsAbility to manage, organize, document and prioritize multiple tasks simultaneouslyResourcesQNXT, Microsoft Office package, eVIPSFallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. PM16PI160578398

Keywords: Fallon Community Health Plan, Worcester , Provider Information Data Specialist, Other , Worcester, Massachusetts

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